Orthodox Medical View and Approach to Dermatitis

Dermatitis is a broad term covering many different disorders that all result in a red, itchy rash. The term eczema is sometimes used for dermatitis. Below are a number of lesser known forms of Dermatitis as described in the Merck Manual 'Home Edition'.

Nummular Dermatitis

The cause is unknown. Nummular dermatitis usually affects middle-aged people, occurs along with dry skin, and is most common in winter. However, the rash may come and go without any apparent reason.

The round spots start as itchy patches of pimples and blisters that later ooze and form crusts. The rash may be widespread. Often, spots are more obvious on the backs of the arms or legs and on the buttocks, but they also appear on the torso.

Most people benefit from skin moisturizers. Other treatments include antibiotics taken by mouth, corticosteroid creams and injections, and phototherapy (exposure to ultraviolet light). All treatments, however, are often unsatisfactory.

Generalized Exfoliative Dermatitis

Certain drugs (especially penicillins, sulfonamides, isoniazid, phenytoin, and barbiturates) may cause this disorder. In some cases, it is a complication of other skin diseases, such as atopic dermatitis, psoriasis, and contact dermatitis. Certain lymphomas (cancers of the lymph nodes (see Lymphomas: Introduction)) may also cause generalized exfoliative dermatitis. In many cases, the cause is unknown.

Symptoms and Diagnosis

Exfoliative dermatitis may start rapidly or slowly. At first the entire skin surface becomes red and shiny. Then the skin becomes scaly, thickened, and sometimes crusted. Sometimes the hair and nails fall out. Some people have itching and swollen lymph nodes. Although many people have a fever, they may feel cold because so much heat is lost through the damaged skin. Large amounts of fluid and protein may seep out, and the damaged skin is a poor barrier against infection.

Because symptoms of exfoliative dermatitis are similar to those of skin infection, doctors send samples of skin and blood to the laboratory to exclude infection as a cause.

Treatment of Dermatitis

Early diagnosis and treatment are important in preventing infection from developing in the affected skin and in keeping fluid and protein loss from becoming life threatening.

People with severe exfoliative dermatitis often need to be hospitalized and given antibiotics (for infection), intravenous fluids (to replace the fluids lost through the skin), and nutritional supplements. Care may include the use of drugs and heated blankets to control body temperature. Cool baths followed by applications of petroleum jelly and gauze may help protect the skin. Corticosteroids (such as prednisone) given by mouth or intravenously are used only when other measures are unsuccessful or the disease worsens. Any drug or chemical that could be causing the dermatitis should be eliminated. If lymphoma is causing the dermatitis, treatment of the lymphoma is helpful.

Stasis Dermatitis

Stasis dermatitis is inflammation on the lower legs from pooling of blood and fluid.

Stasis dermatitis tends to occur in people who have varicose (dilated, twisted) veins (see Venous Disorders: Varicose Veins) and swelling (edema). It usually occurs on the ankles but may spread upward to the knees. At first, the skin becomes reddened and mildly scaly. Over several weeks or months, the skin turns dark brown. Eventually, areas of the skin may break down and form an open sore (ulcer), typically near the ankle. Ulcers sometimes become infected with bacteria. Stasis dermatitis makes the legs feel itchy and swollen, but not painful. Ulcers are usually painful.

Treatment of Dermatitis

Long-term treatment of stasis dermatitis is aimed at keeping blood from pooling in the veins around the ankles. When sitting, the person should elevate the legs above the level of the heart. Properly fitted prescription support hose (compression stockings) also prevent pooling of blood and decrease swelling. Department store "support" stockings are not adequate.

For dermatitis of recent onset, soothing compresses, such as gauze pads soaked in tap water or aluminum acetate (Burow's solution), may make the skin feel better and can help prevent infection by keeping the skin clean. If the disorder worsens, as evidenced by increased warmth, redness, small ulcers, or pus, a more absorbent dressing can be used. Corticosteroid creams are also helpful and are often combined with zinc oxide paste and applied in a thin layer. Corticosteroids should not be applied directly to an ulcer because this will interfere with healing.

When a person has large or extensive ulcers, special moisture-containing hydrocolloid or hydrogel dressings may be used. Antibiotics are used only when the skin is already infected. Sometimes, skin from elsewhere on the body may be grafted to cover very large ulcers.

Some people may need an Unna's boot, which is a woven stretch wrap filled with a gelatin paste that contains zinc. The wrap is applied to the ankle and lower leg where it hardens, similar to but softer than a cast. The boot limits swelling and helps protect the skin from irritation, and the paste helps heal the skin. At first the boot is changed every 2 or 3 days, but later it is left on for a week at a time.

In stasis dermatitis, the skin is easily irritated; antibiotic creams, first-aid (anesthetic) creams, alcohol, witch hazel, lanolin, or other chemicals should not be used because they can make the disorder worse.

Localized Scratch Dermatitis

Localized scratch dermatitis is caused by chronic scratching of an area of skin. The act of scratching triggers more itching, beginning a vicious circle of itching-scratching-itching. Sometimes the scratching begins for no apparent reason. Other times scratching starts because of a contact dermatitis, parasitic infestation, or other condition, but the person continues to scratch long after the inciting cause is gone. Doctors do not know why this happens, but psychologic factors may play a role. The disorder does not seem to be allergic. More women than men have localized scratch dermatitis, and it is common among Asians and Native Americans. It usually develops between the ages of 20 and 50.

Symptoms and Diagnosis

Localized scratch dermatitis can occur anywhere on the body, including the anus (pruritus ani (see Anal and Rectal Disorders: Anal Itching)) and the vagina (pruritus vulvae (see Symptoms and Diagnosis of Gynecologic Disorders: Vaginal Itching)), but is most common on the head, arms, and legs. In the early stages, the skin looks normal, but it itches. Later, dryness, scaling, and dark patches develop as a result of the scratching and rubbing.

Doctors try to discover any possible underlying allergies or diseases that may be causing the initial itching. When the disorder occurs around the anus or vagina, the doctor may investigate the possibility of pinworms, trichomoniasis, hemorrhoids, local discharges, fungal infections, warts, contact dermatitis, or psoriasis as the cause.

Treatment

For the disorder to clear up, the person must stop all scratching and rubbing of the area. Standard treatments for itching should be followed (see Itching and Noninfectious Rashes: Treatment). Using surgical tape saturated with a corticosteroid helps relieve itching and inflammation and protects the skin from scratching. The doctor may inject longer-acting corticosteroids under the skin to control the itching.

When this disorder develops around the anus or vagina, the best treatment is a corticosteroid cream. Zinc oxide paste may be applied over the cream to protect the area; the paste can be removed with mineral oil.

Perioral Dermatitis

Perioral dermatitis is a red, bumpy rash around the mouth and on the chin.

The disorder, whose cause is unknown, mainly affects women between the ages of 20 and 60.

Treatment is with tetracyclines or other antibiotics taken by mouth. If these antibiotics do not clear up the rash and the disorder is particularly severe, isotretinoin, an acne drug, may help. Corticosteroids and some oily cosmetics, especially moisturizers, tend to worsen the disorder.

Pompholyx

Pompholyx is a chronic dermatitis characterized by itchy blisters on the palms and sides of the fingers and sometimes on the soles of the feet.

Pompholyx is sometimes called dyshidrosis, which means "abnormal sweating," but the disorder has nothing to do with sweating. Doctors do not know what causes pompholyx, but stress may be a factor as well as some ingested substances such as nickel, chromium, and cobalt. It is more common in adolescents and young adults.

The blisters are often scaly, red, and oozing. Pompholyx comes and goes in attacks that last 2 to 3 weeks. Pompholyx takes weeks to go away on its own. Wet compresses with potassium permanganate or aluminum acetate (Burow's solution) may help the blisters resolve. Strong topical corticosteroids may help itching and inflammation.

Traditional / Alternative Medical View and Approach

Dermatitis and eczema are often confused, however, we have adopted the broad guidelines given in the Merck Manual and used these terms synonymously to indicate superficial inflammation of the skin.

Dermatologists do subdivide these terms and provide disease names for each of the subcategories within both eczema and dermatitis. However, this is of little relevance when viewing these conditions from a traditional (alternative) medical view point. The only important sub-division is between those cases where the cause is an internal (endogenous) one, as opposed to a contact or external (exogenous) cause. In exogenous cases it is possible to solve the problem by avoidance of the surface irritant, if it can be identified. Such problems, often referred to as Contact Dermatitis, are commonly caused by, for example:

• industrial solvents, harsh soaps,
• dyes,
• nickel and other metals,
• leather tanning chemicals,
• plant materials

• stress
• mechanical irritation
• heat
• dietary factors are important, especially in children. Milk and milk products are the most common triggers.

System Support
As with all diseases or disorders, traditional approaches to treatment always consider internal 'systemic' weaknesses or susceptibilities as well as the external problem. It is no different with skin disorders, except where the cause is of an obvious nature such as an in Contact dermatitis. Underlying problems with nervous system, digestive system, liver, immune system, etc. will need to be investigated and considered in the holistic approach to the treatment.

Specific Remedies
There are a number of Wildcrafted Herbal Products which may be benefitial to your skin. An approach of both internal and external therapy is usually the most successful.

Internal: Wildcrafted's Alterative Compound and/or Liver Compound
External: Natural Skin Care System for Sensitive Skin

Broader Context of Treatment:
There are a number of additional considerations to be taken into account. Firstly, it is vitally important that a sufficient amount of water (8-10 glasses per day) is consumed. Dehydration can cause the skin to become dry, flaky and itchy which can develop into eczema. In addition, research has shown that children who have not been breast fed, or were weaned too soon, often develop eczema when weaned from breast milk to cows' milk. Using soy, goats or sheep's milk rather than Cow's milk is less likely to trigger allergy problems.

Common triggers which may cause eczema include:

• Cows' milk
• Eggs
• Cheese
• Fish
• Sugar
• Food additives

Irrespective of what the cause of the dermatitis or eczema, it is very important to not just address the skin with topical applications of creams or ointments, but to carefully assess internal weaknesses and systemic disorders which may lie at the base of the skin disorder.

Consult a qualified, experienced health care professional before beginning treating your Dermatitis.

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